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Meta-Analysis
. 2017 Jul 31;12(7):e0181035.
doi: 10.1371/journal.pone.0181035. eCollection 2017.

Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis

Yolanda Rando-Matos  1 , Mariona Pons-Vigués  2   3   4 , María José López  5   6   7   8 , Rodrigo Córdoba  9   10 , José Luis Ballve-Moreno  1 , Elisa Puigdomènech-Puig  11 , Vega Estíbaliz Benito-López  12   13   14 , Olga Lucía Arias-Agudelo  15 , Mercè López-Grau  16 , Anna Guardia-Riera  17 , José Manuel Trujillo  18 , Carlos Martin-Cantera  2   3   16
Affiliations
Meta-Analysis

Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis

Yolanda Rando-Matos et al. PLoS One. .

Abstract

Aims: The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations.

Materials and methods: Systematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment.

Results: A total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significant decreases in the percentage of people suffering from them, especially in locations with comprehensive measures and during the immediate post-ban period (within the first six months). Four (50%) of the papers concerning pulmonary function reported some significant improvement in expiratory parameters. Significant decreases were described in 13 of the 17 papers evaluating asthma hospital admissions, and there were fewer significant reductions in chronic obstructive pulmonary disease admissions (range 1-36%) than for asthma (5-31%). Six studies regarding different respiratory diseases showed discrepant results, and four papers about mortality reported significant declines in subgroups. Low bias risk was present in 23 (46%) of the studies.

Conclusions: Smokefree legislation appears to improve respiratory and sensory symptoms at short term in workers (the overall effect being greater in comprehensive smokefree legislation in sensory symptoms) and, to a lesser degree, rates of hospitalization for asthma.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of literature search and study selection from papers evaluating smokefree legislation effects on respiratory and sensory disorders (1995–2015).
Fig 2
Fig 2. Risk difference between before and after the smokefree legislation (SFL) in any respiratory/sensory symptom.
Abbreviations: CI, confidence interval; df, degrees of freedom; IV, Inverse Variance method.
Fig 3
Fig 3. Mean difference between before and after comprehensive smokefree legislation (SFL) in spirometry parameters.
Abbreviations: CI, confidence interval; df, degrees of freedom; IV, Inverse Variance method.
Fig 4
Fig 4. Risk ratio between before and after comprehensive smokefree legislation (SFL) in asthma, COPD and lung infection admissions.
Abbreviations: CI, confidence interval; df, degrees of freedom; IV, Inverse Variance method.
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References

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